Can You Feel Scar Tissue Under Your Skin

The man body has magnificent intelligence to monitor, maintain, and repair itself 24/7.  These complex, biological functions are the result of millions of years of evolution and of class play a major role in the survival and thriving of our species.

Simply even nature has its faults.  When it comes to injury repair, the torso's repair mechanisms tin inadvertently create a new prepare of issues.

When you sustain tissue harm, whether from sudden trauma such as spraining your ankle or gradual trauma such as a cumulative/repetitive tendinous strain or articulation vesture and tear, your trunk initiates a cascade of events to heal the injured tissue.

First, clotting factors appear and thicken the claret to stop any bleeding (hemostasis).  This is a circuitous concatenation reaction that involves many types of substances, each with a specific office.  Some clotting factors make blood vessel walls more than permeable, assuasive fluids to exit effectually the expanse and accumulate into the extracellular (outside the cells) spaces.   This is why edema, or swelling occurs following an injury.  The purpose of swelling to quarantine the injury site by creating a wall of pressure around it.  The swelling too contains noxious substances ("the inflammatory soup") such equally substance p and arachidonic acid that produce pain and therefore discourage move, protecting against further damage.

While this is happening, cells called fibroblasts start laying down a net of poly peptide fibers called fibrin around the damaged tissue, which could exist skin, muscle, bone or organ.

This gristly net catches red blood cells, which stack up and class a fibrous claret clot, plugging damaged blood vessels and filling in the infinite formed by the injury.  The gristly clot gradually contracts, hardens and pulls damaged tissues together.  The claret clot fabric somewhen thins out, falls off, and may even be picked off by the person.  Underneath, the reparative collagen fibers remain, forming what we call scar tissue.

You tin can observe this process if the injury is superficial such as a gash in the pare, merely this process as well happens in ligament, tendon, muscle and os tissue injuries where there is no harm to the skin above.  If it was a paper cut, you may non see a scar, but if it was a gash/laceration, when it finally heals you lot will see a scar.

Upon close inspection, the scar is lighter in color, feels harder, and is raised.  Now imagine this scar tissue in the ligaments and tendons of a healed sprained ankle, knee or shoulder where in that location is movement and proximity to other structures such as os, muscle, bursae, and nerves.

Unlike the scar tissue of a skin gash, which does not take much physical stress to it, ligaments and tendons by nature are subject to frequent movement and stress (bearing a load).  They are components of all joints in your body, and the role of joints is movement and generating force.  And then, backlog scar tissue in deeper musculus, ligaments and tendons nowadays potential issues, described next.

Going back to the repair process, as the fibroblasts keep to lay down strands of collagen, they do and so in a random, criss-crossed pattern forming the scar tissue.  It's tough and dense, which is skilful for repairing, but tin also pose a problem in a couple of ways.

Commencement, the criss-cross blueprint of scar tissue makes it less elastic (stretchable).  And then subsequently it heals, and the area is after subject to substantial stress, the scar tissue will give, and you'll have a re-injury.  This explains why boxers easily get flesh cuts after getting hit in the correct spot—it's an area of scar tissue from a previous cut that "broke" upon absorbing stress forces.Fibrosis is a term that describes pathological scar tissue; i.e. aberrant scar tissue deposition that causes disease/dysfunction such every bit hurting and restricted movement.

Second, the very dumbo nature of scar tissue tin can cause pain receptors to bunch upwards around it, every bit they cannot penetrate it.  This makes the injury site sensitive afterward healing completes, and contributes to the pain becoming chronic (recurring).  Pocket-sized, focalized areas of pain are called trigger points, as they can trigger pain in other areas when pressed.

Third, scar tissue build up constricts blood vessels, which compromises waste material removal from the area and inhibit oxygen delivery to the area.  In some cases, this results in chronic, low-course inflammation, which contributes to pain sensation.

Fourth, the trunk may try to stabilize scar tissue by calcifying it.  Calcium ions in the blood deposit on the scar tissue, hardening it and making it have rougher edges, which tin can cause restricted and painful movement.  This is common in chronic shoulder injuries.

The bottom line is that scar tissue is essential to healing, simply due to the same reasons it may also pb to pain chronicity, whether it is an acute onset sprain/strain injury; a cumulative strain such as tennis elbow; or pain from tissue degeneration such every bit hip osteoarthritis.

So how does one fix chronic pain caused by backlog scar tissue build upward?

The Ideal Approach to Ensure Proper Soft Tissue Healing, Minimize Scar Tissue and Prevent Chronicity

The best defence is a proficient law-breaking:  immediately later on an injury, follow the standard methods of handling:  apply cold directly to the area; add together some compression, drag the area if possible to help prevent excessive swelling/edema, and residuum the injured surface area for at to the lowest degree two days.  If the pain is unbearable, you tin can take over-the-counter anti-inflammatory medications (not-steroidal anti-inflammatories like Tylenol and Ibuprofen) but I recommend trying to just stick with water ice if you tin can, and tough it out.

As the affectibility subsides, y'all tin introduce passive movement of the injured area.  This stresses the ligaments and tendons only plenty which causes the fibroblasts to lay down the scar tissue collagen fibers in a more organized style, which will result in improve healing/ quality of healed structures.

Then, maybe on the third 24-hour interval do agile movements of the injured area, so a calendar week later, active-resistance movements (weights, resistance bands, swimming pool) to stress the structures in a controlled fashion, encouraging quality remodeling of scar tissue.  You may demand assist from a rehab specialist to estimate how much resistance to use, and when.

And finally and ideally, your injury will be 100% healed, without loss of strength or range-of-motion.

What to Endeavor if Y'all Did Not Rehabilitate Your Injury Properly and Take Chronic Pain and/or Stiffness

But what if you didn't do all of this, and now your pain is chronic, a year after the injury or onset of hurting?  Scar tissue could be the main culprit:  limiting mobility, getting re-injured, attracting pain-sensing nerve endings (forming trigger points), and constricting arterial, venous and lymph flow to and from the injury site causing chronic, low-grade inflammation.

Will estrus exercise the job?  Oestrus such as that delivered by a hotpack vasodilates blood vessels close to the skin.  If you use an infrared heat lamp, you could care for deeper areas such as the hip.  This may help your chronic injury feel better, as more circulation means more oxygen, nutrients, proteins and other substances that benefit cells.  But estrus doesn't practise much to that difficult, rigid scar tissue.  Heat offers temporary relief.

Will electric stim (TENS) aid?  Devices similar TENS that evangelize an electrical current to the skin transcutaneously (through the skin) tin be helpful in temporarily reducing pain perception, merely they do zippo to accost scar tissue.

Volition pulsed EMF assistance?  Pulsed EMF uses magnetic fields to generate pulses of electromagnetic free energy.  PEMF has been used since the 1950s to help heal cleaved basic.  Scientists know that biological tissue reacts to electromagnetic fields.  They affect cell membrane permeability and gene expression, which tin have beneficial furnishings such as reducing inflammation and synthesizing functional proteins.  PEMF may make chronic pain feel meliorate, only information technology does not have any therapeutic effect on scar tissue itself.

Will therapeutic ultrasound assistance scar tissue?  Ultrasound (not the kind used for imaging) is the delivery of high frequency audio waves through the body to generate oestrus.  Ultrasound is popular for treating deep joint structures, peculiarly the shoulder (glenohumeral joint), hip and articulatio genus joints.   Different topically-practical heat, ultrasound heats from the inside of the body.  Sound, physically, is reverberating pressure waves traveling through a medium.  When the ultrasound waves pass through the peel and strike something of higher density; i.eastward. tendons, ligaments or os, it generates heat, but as rubbing your skin really hard will generate oestrus.  The pressure level waves of the ultrasound may be strong enough to loosen some of the scar tissue fibers likewise, making it a skilful selection for treating chronic joint pain.

Will massage therapy assistance?  It can, depending on the nature of the scar tissue.  It's most effective in reducing fibrosis if started during the sub-acute phase, and continuing past the remodeling stage of tissue healing.   Massage is known for its soothing/relaxing effect, simply information technology is too appropriate for soft tissue injuries, specially myofascial release/ trigger point release, deep tissue massage, instrument-assisted soft tissue therapy, and Agile Release technique.  These methods are more than accurately described as "soft tissue mobilization" techniques and involve placing pressure into areas of scar tissue to break them up, stretch them equally they are being laid down by fibroblasts, or to separate scar tissue adhesions—points where scar tissue binds to other structures.

There is another modality that is not well-known to most people that has a high success rate in treating chronic tendinopathies due to scar tissue fibrosis: extracorporeal shockwave therapy (ESWT), or shockwave for brusk.  Shockwave uses pulsed, high energy acoustic (sound) waves delivered right through the skin to physically intermission apart/ thin out underlying scar tissue.  You lot may have heard of how doctors can deliquesce kidney stones using a machine that sends waves through the skin all the way to the kidney stone, without surgery, called lithotripsy.   This is precisely extracorporeal (meaning "exterior the body") shockwave therapy.

Shockwave handling is oftentimes described every bit "ultrasound on steroids" since it uses sound pressure level waves, but at a lower frequency and higher energy.   Think of thunder, clapping hands, and a jet breaking the sound barrier.

When a shockwave enters living tissue and encounters changes in tissue density or impedance (such as from fatty to musculus) it will either be reflected, refracted, transmitted or dissipated just like any other wave.   According to the site Shockwave Therapy Education, energy is released at these interfaces of different impedance values, creating compression and shear loads on the surface of the fabric with the greater impedance (mostly scar tissue, tendons, and ligaments), like very tiny explosions.

The free energy released past shockwaves causes microtrauma (tissue devastation), which triggers the reparative process:  new blood vessels form (neovascularization) and fibroblasts secrete collagen fibers in a more than organized fashion, replacing the old, disorganized scar tissue.  Claret flow improves, and the old, chronic injury undergoes new healing and heals more than completely the second time around.   The restructuring of collagen fibers results in less nociceptors than when fibrosis was present, and the result, after a brief soreness following the microtrauma, is less pain.

Conditions Extracorporeal Shockwave Therapy is used to treat include:

• Plantar fascitis
• Epicondylitis
• Trochanteric bursitis
• Dupruyten's contracture
• Carpal tunnel syndrome
• Achilles, patellar and other tendinopathies
• Post surgical scar tissue fibrosis

Below are video fluoroscopy images of ESWT breaking autonomously a calcaneous (heel) os spur:

TYPES OF SHOCKWAVE MACHINES

In that location are two, main types of shockwave machines, ballistic and piezoelectric.  In a ballistic machine, a small pellet is accelerated back and forth inside a metal tube by stiff electromagnets or past compressed air.  When the pellet strikes inside the terminate of the metallic tube (strikeplate), information technology produces a radial shockwave.  This type of shockwave is considered low-energy, every bit the shockwave dissipates and expands radially as it enters and travels through tissue.

A piezoelectric machine uses an array of tiny crystals at the end of a concave handling head.  An electrical current is passed through the crystals, which causes them to quickly expand and contract, generating pulsed acoustic pressure waves.  A silicone cone attachment is affixed to the handling head to conduct, focus and direct the shockwaves produced by the tiny crystals.

The shape of the cone zipper and the output voltage determine the depth to which the soundwave travel.  Piezoelectric machines are considered high-energy, as the acoustic wave is focused into a pocket-size surface area and does not dissipate much.  These machines therefore are used with more circumspection.

Bottom LINE:

Scar tissue is like biological "glue" the torso uses to repair injuries to itself, but it tin crusade problems long afterwards the injury heals.  Scar tissue fibrosis is a mass of hardened poly peptide strands laid downward haphazardly by fibroblasts at the injury site.   It is often a factor in chronic musculoskeletal pain.  It develops in injuries, such every bit shoulder and knee strains, and is worse if the injury is not properly treated/ rehabilitated.  Scar tissue perpetuates chronic pain by inhibiting proper movement of soft tissue structures– tendons, ligaments, fascia and muscles, which can cause abrasion to adjacent tissues; inhibit vascular flow to the area; and crusade sensory nervus endings to bunch together.  Extracorporeal Shockwave Therapy (ESWT) is a treatment that uses loftier-energy pressure level waves to break downwardly scar tissue fibrosis so that new, organized fibers can replace it; abrasion and congestion are reduced, and movement and strength are improved.  It is a highly-effective modality for tendinopathies and similar musculoskeletal diseases, with some studies finding an 80% success rate.

For more a more in-depth explanation of how extracorporeal shockwave therapy works, watch my interview with Dr. Ulyss Bidkaram, a chiropractor who uses ESWT in his practice:

REFERENCES:

Shockwave Education

http://www.shockwavetherapy.education/index.php/theory/biological-furnishings

Angela Notarnicola and Biagio Moretti. The biological effects of extracorporeal daze wave therapy (eswt) on tendon tissue.  Muscles Ligaments Tendons J. 2012 Jan-Mar; 2(1): 33–37.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666498/

Semra Aktürk,i,* Arzu Kaya, et al.  Comparision of the effectiveness of ESWT and ultrasound treatments in myofascial pain syndrome: randomized, sham-controlled report, J Phys Ther Sci. 2018 Mar; xxx(3): 448–453.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857456/

Epitome credits:

https://www.biodermis.com/what-are-the-stages-of-wound-healing-south/221.htm

http://www.shockwavetherapy.education/index.php/theory/biological-effects

https://www.verywellhealth.com/what-is-rice-190446

https://www.pediagenosis.com/2019/10/exercises-for-range-of-move-and.html

https://world wide web.verywellhealth.com/what-is-rice-190446

Source: https://painandinjurydoctor.com/uncategorized/what-is-scar-tissue-and-how-do-i-get-rid-of-it/

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